| NPI | 1912262726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036144036) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 64467) |
| 207R00000X Internal Medicine (Licence: MI 4301101673) | |
| Enumeration Date | 2012-07-08 |
| Last Update Date | 2021-03-22 |